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Health condition · Clinically reviewed

Complex Regional Pain Syndrome, an early MDT plan changes the outcome.

A limb with severe, disproportionate pain after a fracture, surgery or minor injury deserves a fast, structured assessment against the Budapest criteria - not months of waiting.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, the Royal College of Physicians and the Royal College of Anaesthetists CRPS guidance.

  • 03

    Current for 2026

    Reflects modern UK guidance including the Budapest criteria, MDT rehabilitation and neuromodulation pathways.

Key facts

CRPS at a glance.

The essentials, in plain English - what CRPS is, who it affects, how it is diagnosed and why timing matters.

  • What it is

    A chronic pain condition affecting a limb, with pain that is severe and out of proportion to any initial injury.

  • Two types

    Type 1 (no identifiable nerve injury, around 90% of cases) and Type 2 (with a defined nerve injury, previously called causalgia).

  • Who it affects

    Women more often than men (about 3 to 4 to 1). Any age but a peak between 30 and 60. Peak trigger is fracture, especially of the wrist.

  • How it is diagnosed

    Clinical diagnosis using the Budapest (IASP) criteria. There is no single confirmatory test. Examination is critical.

  • Mechanism

    Peripheral and central nervous system changes with neuroinflammation, autoimmune features and altered microcirculation.

  • Why timing matters

    Early diagnosis and rehabilitation give a much better outcome. Delayed treatment risks a chronic, disabling course.

Why this guide matters

An early MDT plan, not a slow drug ladder.

CRPS is treatable, particularly when recognised early. The three points below shape everything else on this page.

  • Early diagnosis is everything

    The Budapest criteria let a specialist reach a diagnosis without waiting for a test result. Early recognition transforms the outcome.

  • Rehabilitation is the mainstay

    Physiotherapy, occupational therapy, graded motor imagery and mirror therapy do more for function than any drug on its own.

  • Neuromodulation for refractory CRPS

    For chronic, refractory disease, spinal cord and dorsal root ganglion stimulation are evidence-based options in specialist hands.

How the diagnosis is made

From trigger injury to a Budapest-criteria diagnosis.

The steps a UK GP, pain specialist or rehabilitation consultant will normally follow, in order.

  1. 01

    Assessing

    History and trigger review

    A careful timeline of a fracture, surgery, immobilisation or minor injury. Around 10% of cases are spontaneous.

  2. 02

    Assessing

    Structured limb examination

    Sensory, vasomotor, sudomotor and motor changes assessed side by side with the unaffected limb.

  3. 03

    Assessing

    Apply the Budapest criteria

    Four categories of symptoms and signs (sensory, vasomotor, sudomotor/oedema, motor/trophic) with no better explanation.

  4. 04

    Confirming

    Exclude mimics

    Rule out deep vein thrombosis, infection, undiagnosed fracture, compartment syndrome and peripheral neuropathy.

  5. 05

    Confirming

    Supportive investigations

    Three-phase bone scan, MRI, X-ray, quantitative sensory testing and thermography can support but never replace clinical diagnosis.

  6. 06

    Planning

    Refer to a specialist pain service

    Early referral to an MDT chronic pain clinic, or one of the UK specialist CRPS centres, if the picture fits.

  7. 07

    Planning

    Plan rehabilitation from day one

    Physiotherapy, occupational therapy and psychology are set up in parallel with medication, not after it.

Typical timeline: a specialist review and MDT plan within weeks of the first suspicion.

Symptoms

What CRPS actually looks like.

The Budapest categories in real life - sensory, vasomotor, sudomotor and motor changes, and how warm CRPS shifts into cold CRPS.

  • Severe, disproportionate pain

    Deep, burning, constant pain that is far greater than the original injury would predict.

  • Allodynia and hyperalgesia

    Light touch, clothing or a breeze can trigger intense pain. Painful stimuli feel amplified.

  • Sensory change

    Hyperaesthesia and patchy numbness in the affected limb, often in a non-dermatomal pattern.

  • Colour and temperature change

    The limb may look red, blue, pale or mottled. A temperature difference of more than 1 degree between sides is typical.

  • Swelling and sweating changes

    Oedema and altered sweating on the affected side. Skin can look shiny or thickened.

  • Motor and trophic changes

    Weakness, tremor, dystonia and reduced range of movement. Nail, hair, skin atrophy or thickening over time.

  • Warm CRPS to cold CRPS

    Early disease (weeks to months) often looks warm and swollen. Later, chronic disease often looks cold, stiff and wasted.

  • Red flag - rapid dystonia or spread

    Fixed dystonia, rapid spread to another limb or severe functional loss needs urgent specialist review.

Treatment

How CRPS is treated in the UK.

MDT rehabilitation is the mainstay. Medication, interventional procedures and neuromodulation are added when needed, in specialist hands.

  • MDT rehabilitation

    The mainstay of care. Physiotherapy, occupational therapy, graded motor imagery, mirror therapy, desensitisation and pacing.

  • Neuropathic medication

    Gabapentin, pregabalin, amitriptyline, nortriptyline or duloxetine, chosen and titrated by the pain team.

  • Bisphosphonates

    Pamidronate, neridronate or zoledronate have evidence in early CRPS and are used in selected patients.

  • Vitamin C after wrist fracture

    Prophylactic 500 mg daily for around 50 days after distal radius fracture has some evidence for reducing CRPS risk.

  • Ketamine infusions

    Subanaesthetic ketamine in a specialist pain setting for severe, refractory CRPS. See our ketamine clinic guide.

  • Sympathetic nerve blocks

    Stellate ganglion or lumbar sympathetic blocks in selected cases. Evidence is mixed but can help some patients.

  • Spinal cord and DRG stimulation

    Neuromodulation for chronic, refractory CRPS. Dorsal column and dorsal root ganglion stimulation are established options.

  • Pain psychology

    CBT, ACT and trauma-focused work reduce disability and distress and are part of every specialist plan.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or pain specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • Royal College of Physicians. Complex regional pain syndrome in adults: UK guidelines for diagnosis, referral and management.

  • Royal College of Anaesthetists / Faculty of Pain Medicine. CRPS pathway and neuromodulation guidance.

  • NICE. Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173).

  • International Association for the Study of Pain (IASP). Budapest diagnostic criteria for CRPS.

Red flags

When CRPS needs urgent attention.

These are the situations where a routine appointment is not enough - and where a specialist opinion or urgent assessment is needed.

  • Rapid spread to another limb

    Spread beyond the original limb, or to the contralateral side, needs urgent specialist pain input.

  • Fixed dystonia

    A limb locked in an abnormal posture is a serious motor sign that should not wait for a routine appointment.

  • Suspected DVT or infection

    A hot, swollen, red limb can look like early CRPS. Rule out deep vein thrombosis, cellulitis or septic arthritis first.

  • Undiagnosed fracture or compartment syndrome

    Escalating pain after trauma with pain on passive stretch is a surgical emergency, not CRPS.

  • Severe psychological distress

    Chronic pain carries a real mental-health burden. Low mood or suicidal thoughts need urgent GP or crisis support.

  • Loss of function or self-care

    Inability to wash, dress or work needs urgent occupational therapy and pain team input.

  • Ulceration or skin breakdown

    Trophic skin changes with ulceration need specialist wound and vascular assessment alongside pain care.

  • Children and adolescents

    Paediatric CRPS behaves differently and needs a specialist paediatric pain service from the outset.

  • Suspected medication harm

    High-dose opioids rarely help CRPS and can cause harm. Any escalating opioid use should trigger a specialist review.

Living with it

A serious condition, with a real path forward.

Four things that make the biggest difference day to day - gentle movement, pacing, an MDT team around you and connection with the CRPS community.

A quiet reminder

Consistency beats intensity, every time.

With CRPS, small daily steps kept up for months usually do more than a heroic week that triggers a flare.

  1. 01 Move

    Keep the limb in use, gently

    Graded, pain-informed movement protects range, circulation and function. Complete rest usually makes CRPS worse.

  2. 02 Pace

    Shift from pain to time

    Pacing by the clock, not by how you feel, is the most reliable way to build capacity without repeated flare cycles.

  3. 03 Team

    Use the whole MDT

    Physiotherapy, occupational therapy and psychology work best together. Medication alone rarely restores function.

  4. 04 Support

    Find your people

    Burning Nights CRPS Support and specialist UK CRPS centres offer information, peer support and advocacy.

Frequently asked

Everything we get asked about CRPS.

Quick answers on Budapest criteria, rehabilitation, medication and specialist neuromodulation options.

  • What is Complex Regional Pain Syndrome (CRPS)?

    CRPS is a chronic pain condition affecting a limb, usually after an injury, surgery or a period of immobilisation. Pain is severe and out of proportion to the trigger, with sensory, colour, temperature, swelling, sweating and motor changes. It was previously called Reflex Sympathetic Dystrophy (RSD) and causalgia.

  • What is the difference between CRPS Type 1 and Type 2?

    CRPS Type 1 is diagnosed when there is no identifiable nerve injury. It accounts for around 90% of cases. CRPS Type 2 is diagnosed when there is a defined nerve injury, and was previously called causalgia. The clinical picture and treatment are broadly the same.

  • How is CRPS diagnosed?

    CRPS is a clinical diagnosis using the Budapest (IASP) criteria. There is no single confirmatory test. The diagnosis requires ongoing disproportionate pain and features across at least three of four categories (sensory, vasomotor, sudomotor/oedema, motor/trophic), with no better explanation. Bone scan, MRI, X-ray, quantitative sensory testing and thermography are supportive, not diagnostic.

  • What is the best treatment for CRPS?

    The mainstay is early multidisciplinary rehabilitation with physiotherapy, occupational therapy, graded motor imagery, mirror therapy, desensitisation and pain psychology. Neuropathic medication, bisphosphonates in early disease, ketamine infusions in severe cases, sympathetic blocks, spinal cord and dorsal root ganglion stimulation and intrathecal therapy have a role for selected patients. Early treatment matters more than any single drug.

  • Can CRPS be prevented after a wrist fracture?

    There is some evidence that prophylactic vitamin C (around 500 mg daily for 50 days) after a distal radius (Colles) fracture reduces the risk of CRPS. Early mobilisation, appropriate pain control and avoiding prolonged unnecessary immobilisation also help.

  • Where can I get specialist help for CRPS in the UK?

    Care should ideally be led by a specialist chronic pain MDT. UK specialist CRPS centres include services in Bath, Sheffield, Guy’s (London), Salford and Cardiff. The charity Burning Nights CRPS Support offers information, peer support and advocacy. Access to Work and Personal Independence Payment can help with the occupational impact.

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